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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SEROTONIN SURGE CHARITIES
CO JOHN CHUCK
Employer identification number
68-0411254
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) COMMUNICARE HEALTH CEN
2040 SUTTER PLACE
DAVIS,CA95616 		  30,000 0      
(2) ELICA HEALTH CENTERS
1860 HOWE AVE STE 440
SACRAMENTO,CA95816 		  12,500 0      
(3) HEALTH OF LIFE ORGANIZ
7275 E SOUTHGATE DR 204
SACRAMENTO,CA95823 		  12,500 0      
(4) PEACH TREE HEALTH
1114 YUBA ST STE 144
MARYSVILLE,CA95901 		  12,500 0      
(5) REGENTS OF UC
2315 STOCKTON BLVD
SACRAMENTO,CA95817 		  100,000 0      
(6) SACRAMENTO LOAVES & FISHES
1351 N C STREET
SACRAMENTO,CA95811 		68-0189897   7,500 0      
(7) SSVMS
5380 ELVAS AVE STE 101
SACRAMENTO,CA95819 		  15,000 0      
(8) WELLSPACE HEALTH
1820 J STREET
SACRAMENTO,CA95828 		  20,000 0      
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
7
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) SCHOLARSHIP 13 13,000      
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I (Form 990) 2021



Additional Data


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Software Version: 2021v4.0